REM-HF - Remote monitoring: an evaluation of implantable devices for management of heart failure patients

Presented at the ESC congress 2016 by: Martin R. Cowie (London, United Kingdom)

Background

Despite advances in heart failure care, the risk of dying and hospitalisation remains high. Many patients with heart failure (HF) have cardiac implantable electronic devices (CIED: CRT-D or CRT-P). Until now, randomised controlled studies into the utility of remote monitoring have yielded mixed results, possibly as a consequence of patient characteristics, the type of technology used for monitoring, and how to deal with the collected data.
The REM-HF study was designed as a pragmatic study of a care pathway that is informed by weekly remote monitoring with typical CIEDs, to assess its effect on mortality and hospitalisation. A multicentre, prospective, randomised, non-blinded, controlled study was conducted that compared standard care plus weekly remote monitoring with standard care alone. 1650 patients were included between September 2011 and March 2014. Median follow-up was 2.8 years (range: 0-4.3 years).

Main results

• No significant difference was seen between the two treatment groups with regard to the primary endpoint of all-cause mortality or CV hospitalisation (HR: 1.01, 95%CI: 0.87-1.18, P=0.87).
• No difference was seen between groups in any of the secondary endpoints.
• None of the baseline characteristics (age, sex, NYHA class, type of device, history of coronary artery disease, history of atrial fibrillation) identified a group that benefitted more from adding remote monitoring to standard care.
• For 72.5% of participants (599) some sort of action was taken by the person monitoring the data remotely (3545 incidences).

Conclusion

This study suggests that in well-developed healthcare systems with high quality heart failure care, the use of data of weekly remotely monitored CIEDs likely does not improve outcome of patients. “Results from this trial, in a setting intended to maximize the benefit of remote monitoring, do not support its routine use in the management of patients with CIEDs,” commented Martin R. Cowie in a press release. “The assumption that ‘more data improves outcomes’ is not true,” he added. “If patients are well-treated already, and have well-controlled symptoms, looking at remotely collected data weekly is no better than usual care.”
Further technological innovation in remotely monitoring patients requires robust evaluation prior to broad clinical adoption. During the press conference, Cowie added that clinicians should not promise too much about digital technology. Remote monitoring per se will likely not lower mortality: there must be another mechanism. Thus far, no study has shown benefit in a randomised study, of forcing to look at more data. It is all about intelligent use of data.

Our reporting is based on the information provided during the ESC congress